- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,875.83 / $16,331.60 / $21,323.30
| Facility | | $7,875.83 | $16,331.60 | $21,323.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,914.14 / $39,937.14
| Facility | | $5,840.42 | $14,914.14 | $39,937.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,227.92 / $15,258.57 / $23,055.88
| Facility | | $9,227.92 | $15,258.57 | $23,055.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,668.74 / $21,668.74 / $21,668.74
| Facility | | $21,668.74 | $21,668.74 | $21,668.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,295.63 / $15,371.63 / $23,737.41
| Facility | | $13,295.63 | $15,371.63 | $23,737.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,914.14 / $39,937.14
| Facility | | $5,840.42 | $14,914.14 | $39,937.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,914.14 / $31,211.23
| Facility | | $5,840.42 | $14,914.14 | $31,211.23 |